Provider Demographics
NPI:1912068859
Name:BURROWS, GREGORY D (OD)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:D
Last Name:BURROWS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:617 CHIEF ST
Mailing Address - Street 2:
Mailing Address - City:BENKELMAN
Mailing Address - State:NE
Mailing Address - Zip Code:69021-0686
Mailing Address - Country:US
Mailing Address - Phone:308-423-2152
Mailing Address - Fax:308-423-2153
Practice Address - Street 1:617 CHIEF ST
Practice Address - Street 2:
Practice Address - City:BENKELMAN
Practice Address - State:NE
Practice Address - Zip Code:69021-0686
Practice Address - Country:US
Practice Address - Phone:308-423-2152
Practice Address - Fax:308-423-2153
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2008-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE814152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025232000Medicaid
NE10025232000Medicaid
NE099634Medicare ID - Type Unspecified
NE5271760002Medicare NSC